Houston Form 22 15 – Fill Out and Use This PDF

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CONFIDENTIAL - BUSINESS

*NEWPP130*

Harris County Appraisal District

Business & Industrial Property Div.

*2013*

Houston TX 77292-2007

PERSONAL PROPERTY RENDITION

PO Box 922007

January 1, 2013

Form 22.15 (02/13)

For assistance with this form please refer to instructions 22-15-INS at www.hcad.org/forms/

Part 1. Property Owner Name, Address, and Physical Location or Situs [Required]:

Account Number __________________

Business Name ________________________________________

Business Owner ______________________________________

iFile™ Number

__________________

Mail Address

________________________________________

Property Address ______________________________________

Agent's Name

__________________

Mail Address

________________________________________

City/State/Zip

______________________________________

Agent ID No.

__________________

City/State/Zip

________________________________________ Ownership Type (optional)

Individual

Corporation

Partnership

Other _____________________

Part 2. Business Information: Please address all that apply. Optional but very important.

Business Type

Manufacturing

Wholesale

Retail

Service

Business Sold: Date _________ Phone No. ___________________

Business Description ____________________________

SQFT Occupied _______________

New Owner (if sold) ____________________________________________

Business Start Date at Location ____________________ Sales Tax Permit _______________

Mail Address

________________________________________________

Business Moved: Date ____________ New Location_____________________________

City/State/Zip

________________________________________________

Business Closed: Date ____________ Assets in place on Jan 1?

Y

N

Business Owned No Assets as of Jan 1

Part 3. Affirmation of Prior Year Rendition: Check only if applicable and your personal property assets on January 1, were exactly the same as those assets contained in the most recent rendition statement filed.

I affirm that the information contained in the most recent rendition statement filed by the property owner in a prior tax year is accurate with respect to the current tax year in accordance with Section 22.01(I) of the Texas Property Tax Code. [If checked, you may skip to "Signature and Affirmation"]

Part 4. Description of Assets: A description of assets is required unless you checked Part 3 of this form. Below, please check all that apply.

Part 5. Market Value: What do you estimate to be the total market value of your business assets? [Required, unless you checked Part 3 of this form.]

Under $20,000 [If checked Page 2 is optional as long as a general description of the property by type or category has been provided in Part 4]

$20,000 and over [You must complete all of Page 2. Original Cost (Historical Cost) and year acquired can be provided in lieu of a Good Faith Estimate of Value.]

Complete the signature block below and return the form to the address shown above. Unless you receive an extension (see instructions), your form must be delivered or postmarked no later than April 15, 2013.

Signature and Affirmation: Information contained in this rendition and all attachments, if any, is accurate and complete to the best of my knowledge and belief.

Owner/Agent Signature	Title	Printed Name	Date
Company Name		Email (optional)	Phone No.

If you make a false statement on this form, you could be found guilty of a Class A misdemeanor or a state jail felony under Section 37.10, Penal Code.

If you fail to timely file a rendition or property report required by Texas law, the chief appraiser must impose a penalty in an amount equal to 10 percent of the total taxes due on the property for the current year. If the court determines that you filed a false rendition or report with the intent to commit fraud, or to evade the tax, or you alter, destroy, or conceal any record, document, or thing or present to the chief appraiser any altered or fraudulent record, document, or thing, or otherwise engage in fraudulent conduct for the purpose of affecting the outcome of an inspection, investigation determination, or other proceeding before the appraisal district, the chief appraiser must impose an additional penalty equal to 50 percent of the total taxes due on the property for the current year.

Page 1

Page 2 is Optional if Part 3 is checked OR if "Under $20,000" is checked in Part 5 on Page 1

Owner Name:	_________________________________________	Account Number: ___________________________
September 1, Inventory Appraisal - Check this box if you made written application to the appraisal district for September 1 inventory appraisal by July 31, 2012. Enter cost data or your good
faith opinion of market value for your inventory as of September 1. Cost data or owner's good faith estimate for assets other than inventory must be as of January 1.

Part 6. Inventory, Supplies, Raw Materials, Work in Process, and Consigned Goods. Original cost can be provided in lieu of a Good Faith Estimate of Value.

Description	A. Inventory	B. Supplies	C. Raw Materials	D. Work in Process	E. Assets You Own, Leased. Loaned, Consigned, Rented, etc., to Others
					Value	Description	Location
Good Faith Estimate of
Market Value*
Original Cost
(optional)

Part 7. Fixed Assets: (should include expensed and fully depreciated assets): Original cost and year acquired can be provided in lieu of a Good Faith Estimate of Value.

A.

B.

C.

D.

E.

F.

G.

Description

Furniture &

Office

Mobile Radio,

All Other

Computers:

Computers:

Miscellaneous

Describe Miscellaneous Assets

Fixtures

Machines

Telephone, PBX,

Machinery &

PCs, Servers &

Mainframes

(signs, rental

(from column G)

Cell Phone, Fax

Equipment

Peripherals

inventory, etc.)

Good Faith Estimate of

Market Value*

1998 & Prior

1999

2000

(optional)

2001

2002

2003

2004

Cost

2005

2006

Original

2007

2008

2009

2010

2011

2012

Cost Totals

Part 8. Personal Property Leased, Loaned, Consigned, or Rented to You.

Property Owner's Name, Address, and Phone Number

Description

Selling Price in Lease

Annual Rent

(Optional)

(Optional)

Part 9. Personal Property You Manage or Control as a Fiduciary

Property Owner's Name, Address, and Phone Number

Description

Quantity / Units

SQFT Occupied

(Optional)

(Optional)

Location of assets (if different from page 1) ___________________________________________________________________________________________

*If "Over $20,000" is checked in Part 5 and original cost is not provided, the chief appraiser may later ask you to provide a supporting statement detailing the basis for your good faith estimate of market value.

Page 2